Hot flashes, night sweats, cold flashes, and chills. We asked Dr. JoAnn Pinkerton, executive director of the North American Menopause Society, about the what, whys, and what-to-dos of erratic temperature fluctuations during perimenopause.
What are hot and cold flashes, and why do we get them?
About 80 percent of 10 women get them, but for 20 to 30 percent of those women, they’re brutal. Women who get hot flashes have more sensitive thermostats in their brain, so they get hot or cold within a narrower range of temperatures. For pre-menopausal women who are symptomatic, the shivering threshold is higher and the sweating threshold is lower — meaning the thermostat zone is reduced — so that even slight changes in core body temperature can cause a hot flash or sweating, or a cold flash or chills. For most women, hot flashes feel like a warmth spreading up and over them. But for those unfortunate few, they may feel like a burning or intense heat over the upper body along with severe sweating or soaking night clothes and sheets.
What triggers hot flashes?
Hot flashes occur due to hormonal changes, when the body believes it is too hot and chemicals from the brain cause the blood vessels to dilate. Unfortunately, it is not known why some women have severe hot flashes, while others have no hot flashes or mild ones that resolve quickly. The suspected triggers are hot food and drinks, caffeine, alcohol (particularly red wine), spicy foods, and poor air movement.
What are the best ways to cope when perimenopause turns up the heat?
Staying cool and reducing stress will help you handle hot flashes. Keep your room cool and use a fan. Avoid triggers. Wear breathable clothing in layers, so you can add or remove easily as needed. And when you begin to get a hot flash, try taking slow, deep breaths; take off a layer of clothing; drink something cold; or put a cold washcloth on the back of your neck.
Be prepared for different scenarios. If you’re shopping for groceries and a hot flash strikes, head to the freezer section and pick up a piece of ice. You could also buy a cold drink and hold the can or bottle on your neck. Alternatively, buy in a portable pocket fan and carry it with you wherever you go. Exercise regularly — but not too close to bedtime — and reduce stress with activities such as meditation, yoga, qigong, tai chi, biofeedback, acupuncture, and massage.
What causes night sweats, tossing and turning, and soaking through the bedsheets?
Many women have night sweats, but sleep disruption is more common — both difficulty falling asleep and waking up multiple times during the night. This is because dream sleep (REM sleep) is disrupted and shortened due to a decline in estrogen levels. Body temperature peaks late in the afternoon and early morning hours — so if your thermostat is narrowed, you will be more likely to have hot flashes or sweats at those times. Bioidentical hormones can improve sleep, diminishing disruptions and increasing REM.
Why do we heat up so fast and chill so quickly?
It’s not uncommon to feel excessively hot with an urgent need to cool down, and then not too long afterward feel chilled and want to be in front of a heater. The narrowed temperature zone on both sides, hot and cold, is caused by hormone fluctuations.
What causes cold flashes and chills?
If you’re suddenly very cold despite a warm room, this could be a cold flash. When the part of your brain responsible for regulating your body temperature is overactive, your body can shed too much heat and chills occur. It’s because chemicals cause your brain to raise the normal temperature set point, which causes you to feel cold and shiver to help your body’s temperature rise to meet the new set point. A cold flash may follow a hot flash or occur by itself. It can be triggered by a cold drink, cold weather, emotional chaos, or just a hormonal change.
Are there other potentially difficult or debilitating symptoms we should know about?
Some women have dizziness or heart palpitations with the hormonal fluctuations. Others may have mood changes, more irritability, or cry easily. Consult with your doctor for ways to address hot and cold flashes that work best for you.